<p>Concurrent extreme heat (CEH) in distant regions greatly threatens globally interconnected societies. This study reveals that the contrasting circulation regimes of the negative Pacific-Japan (PJ) pattern—a tropical cyclonic anomaly and a mid-latitude anticyclonic anomaly—favor CEH in South China (SC) and Northeast Asia (NEA). Anomalous subsidence primarily drives the CEH, via enhancing adiabatic heating, reducing cloud cover and increasing solar heating. From a large-scale perspective, the subsidence over both regions is promoted by PJ-related tropical convection via zonal and meridional vertical cells. However, distinct regional circulation anomalies, with northerly over SC versus the central–western anticyclone sector over NEA, manifest different local dynamic and thermodynamic adjustments. Diagnoses using the quasi-geostrophic ω equation indicate that cold advection and downward-increasing vorticity advection contribute to the initial subsidence, but the former (latter) is more important for SC (NEA). Regarding temperature advection, climatological wind transports colder air toward the warming center for both regions, while anomalous northerly over SC additionally advects climatologically colder air. Regarding vorticity advection, the underlying surface thermal effect favors stronger climatological relative vorticity gradients at the lower level over both regions and consequent lower-level stronger vorticity advection. Meanwhile, southerly anomaly prevails over NEA with smaller amplitude at the lower level, yielding lower-level weaker negative advection of planetary vorticity and reinforcing the vertical difference. Additionally, the heat in NEA is further supported by downward longwave radiation due to southeasterly moisture transport embedded in the mid-latitude anticyclone. These results underscore that CEH could emerge under contrasting circulation regimes through distinct local processes. </p>